My Story: The day my heart changed my mind

The pain rose slowly into my throat.  As the pain rose, my heart rate started to go up and my mind started racing.  My thoughts quickly went to all of the things I had learned in medical school about heart disease.  I was the perfect age for it, I had several risk factors that I had largely ignored, and the pain was exactly the sort of pain I had warned hundreds of patients about over the years.  As the pain rose and spread through my chest, I began to feel a vague numbness in my left arm.  My training as a doctor was telling me that there was every chance that the coronary arteries serving blood to the large muscle pumping in my chest could be blocked.  Those blockages could be causing angina, the chest pain that precedes a heart attack.  I half expected to be in the emergency room hours later.  But the pain began to slowly subside and then left all together.  Perhaps this was just some kind of warning, and my heart attack was weeks or months away?  It is never recommended that any physician become their own doctor.  I was fully aware of this, so when the chest pain returned the next day and the day after that, I contacted my own physician.   

First, we assessed my risk factors for cardiovascular disease, and we discovered that I was overweight with increased abdominal fat. I had markedly elevated cholesterol, evidence of inflammation and I had prediabetes (a precursor condition on the road to full blown diabetes itself).  These risk factors made the chest pain even scarier so my doctor referred me urgently to a cardiologist for evaluation.  About a week later, I was running up hill on a treadmill hooked up to EKG electrodes.  The techs performing the test were impressed with how far I was able to go on the stress test.  I exercised to 15 METS, a level of exercise well into the 95th percentile for my age (early 50s) and the test was mostly negative.  This gave us some reassurance that maybe the pain might not related to blocked arteries at all.  But the pain persisted.  It occurred most often when I was stressed out about work or home life, but it was with me on most days.

So, my doctor and I decided to do a follow up test that uses CT scan to detect calcium deposits in the coronary blood vessels.  That test was very much positive.  My coronary blood vessels lit up with evidence of calcified “plaque” lining them.  Plaque is the hard mixture of fat and blood clot that forms inside blood vessels over time.  When plaque has been present for some time, the body tries to heal the plaque and it leaves behind calcium deposits that can be seen on a CT scan.  My blood vessels were chocked full of these calcium deposits.  What was more troubling was that the calcium deposits were mostly centered in the infamous “left anterior descending” artery.  This blood vessel is callously nicknamed the “widow maker” by doctors like me.  It serves up blood to the largest part of the heart and if it becomes blocked fully… well the nickname is justified.

So, at this point, here is what I knew:

• I knew that I had numerous risk factors for the development of heart disease like high cholesterol, weight gain, excess abdominal fat and prediabetes.

• I knew that I had substantial amounts of plaque lining my coronary arteries that put me at risk of a heart attack.  What was even more critical was that I knew that the plaque was located in the left anterior descending artery and that if a heart attack were to occur it would be a substantial one.

• I knew that I might have a little time, because the stress test was negative.  But that situation could change quickly if I didn’t do something about it.

As I worked with the cardiologist to address my issues, I began to realize that he was following the traditional approach that I had been taught in medical school and that I have used for most of my career with my own patients.  That approach involves an assessment for severe disease and imminent heart attack (the stress test) and then risk factor modification using “statin” drugs to lower cholesterol.  The cardiologist made passing reference to diet but no reference whatsoever to exercise and fitness, sleep or stress level.  The approach was almost exclusively based on the use of these statin drugs. That was it.

In the current age, this approach is completely inadequate.  Statin drugs have side effects and they don’t completely reverse the progression of heart disease for people with metabolic issues.  In fact, in some cases, statin drugs can make the situation worse by increasing the likelihood that someone will develop diabetes.  That right, it is now a well-established scientific fact that high doses of potent cholesterol lowering medicines increase the likelihood of diabetes in susceptible people.  Lifestyle treatments like diet and exercise, by contrast, have been proven to reverse the risk of heart disease and they have also been shown to be more effective than medicines at preventing the progression from prediabetes to diabetes. 

The problem with lifestyle changes is that everyone knows they should do them but its hard to find the time and it’s hard to create the right habits to sustain them over time.  Although I, myself, had always been an avid runner and I tried to eat right, I clearly was not doing enough because I gained weight and my metabolism was clearly showing signs of problems.  Faced with chest pain, known heart disease, abdominal fat accumulation and prediabetes, I was determined to ambitiously change this situation and adopt an aggressive lifestyle program.  My goal was to minimize the use of medicines like statins although not exclude them entirely from my program.  I wanted to be on the lowest doses of these drugs that would get the benefit without side effects and use lifestyle changes as my primary treatment.

To get to the ideal lifestyle program, I adopted an approach of performing mini “experiments” on myself.  As a physician, I knew which laboratory parameters were likely to change if I was making progress.  I measured these parameters periodically as I amped up my approach to diet, exercise, sleep and stress management.  I kept careful notes as I went along so that I would know which things had made the best impact and which were not helping very much.  My notes also included practical matters like which foods I just couldn’t live without and which exercises I thought I could sustain.  In the end, my lifestyle program along with judicious use of modern medicines was dramatically successful.  Today, I no longer have chest pain, I weigh 10 lbs. less than when I started, my fitness level is as high as it was in my 20s and I am as happy as I have ever been in my life. 

This program is intended to be a guide that will allow you to do the same thing that I did. When you finish, you will have a perfectly tailored lifestyle program that will meet your needs for years to come.